Nov 30, 2011

The psychological backlash against Hickie and McGorry

It’s not only psychologists at war over mental health reform -- considerable vitriol is also being directed at the country’s most prominent psychiatrists, Ian Hickie and Pat McGorry. Crikey's series on mental health reform continues.

Melissa Sweet

Health journalist and Croakey co-ordinator

After years of neglect the federal government has shovelled billions of dollars into the mental healthcare system — but the debate on how best to spend it has just begun. In the second of a four-part joint investigation with Inside Story, health journalist and Croakey blogger Melissa Sweet examines the vitriol directed at mental health campaigners Ian Hickie and Pat McGorry …

It’s not only psychologists who have been tearing each other to shreds (as outlined in part one of this series). Considerable vitriol is also being directed at two of the country’s most prominent psychiatrists, Ian Hickie, executive director of the Brain and Mind Research Institute at the University of Sydney, and Pat McGorry, an Australian of the Year and executive director of Orygen Youth Health in Melbourne, a mental health service that includes the Early Psychosis Prevention and Intervention Centre.

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13 thoughts on “The psychological backlash against Hickie and McGorry

  1. shepherdmarilyn

    Where is the evidence for the backlash or the ideas even working.

    There is zero evidence in the world that psychosis is predictable and can be treated in advance.

    McGorry even wanted to do a study using drugs on healthy kids.

    Now what I have a problem with is everything being called a mental health disease when it is not.

    Anyone can be temporarily unhappy or distressed, that is not a mental health disorder and yet it is treated as if it is.

    My grand-daughter had a small break down last year and put her fist through the wall, she ended up in a psych hospital for a week. It did save here life but no-one predicted or saw that attack coming.

    Now she is a fine, happy, fit and well and working full time and the problem will probably never recur.

    Things happen, people should not be stigmatised for life because they break down like so many are.

    Yet my son who is nuts went undiagnosed until his late teens and was treated for years with drugs that made it worse.

    No-one noticed my son in law was schizophrenic until he stabbed a man in the back over a packet of cigarettes.

    I don’t much care about McGorry and Hickie but they don’t seem to have actually done anything much for the teenagers yet McGorry did good work with refugees we had driven insane.

  2. Just Me

    “One of the reasons for divisions within mental health, Jureidini adds, is the lack of firm evidence about the merits of various interventions. “We’re working in an area of uncertainty. There’s very little concrete evidence to separate one person’s idea from another in terms of their effectiveness.””

    This is the real problem, and what drives the bitter debate. Until psychiatry can come up with more insightful explanations (models), and more effective treatments (especially more accurate and objective measures of therapeutic outcome), then this debate will remain unresolved.

    Hickie in particular deserves some of the criticism he gets, as he is pushing the generic psycho-social model too hard, trying to make it fit where it really doesn’t. Bit too much of the partisan ideological believer in him for me to feel comfortable about his approach.

    The general community has every right to be sceptical and wary of psychiatry’s claims. The profession has not demonstrated it can consistently deliver substantially and unambiguously positive outcomes.

  3. Louise J

    As a clinical psychologist who has worked in the field for more than 20 years I’m very appreciative of this series of articles.

    I totally agree that treatment and prevention programs in this area are historically underfunded in spite of the massive cost to the community of untreated psychological disorders. I am also very pleased, as are most psychologists, that total funding has been increased even though it has been at the expense of services to my own clients under the Better Access Scheme.

    On a few points I would like to differ. Both articles have mentioned “psychologists tearing each other to shreds” – a sensational statement which may have been inferred from comments made in the recent Senate Report. This is not my experience of my profession – even though the two tiered funding has caused division and debate. I’m sure if decisive funding of this nature was imposed on any other profession you would see similar reactions. Most psychologists I know are more concerned with the impact of these changes on the vulnerable people they deal with rather than just lining their own pockets.

    In a similar vein, the tensions and rivalry between the main protagonists could be viewed as typical of spirited academic debate about life and death issues rather than political squabbles over scraps of funding. Psychologists and Psychiatrists do passionately disagree on things; and we are not members of political parties where everyone has to follow the party line. Isn’t vigorous debate a strength rather than a weakness?

    I look forward to the next installment and hope the important issues don’t get sidelined by personality conflict and drama.

  4. Lofi

    McGorry has done more than just step on toes, as unedifying as the spats become. His biggest and potentially most damaging dogma is that of the need to aggressively diagnose psychosis in young people. Apart from the appalling, media/politically driven over-appropriation of money to his pet project, the evidence is NOT in for this kind of approach to youth mental illness. Too-soon diagnosis and pharmacological treatment of teenagers with powerful anti-psychotics is a life-altering decision that should be made based on the advice of a concensus of medical professionals whose conservatism is something to be valued, not denigrated. McGorry has offended these groups with his radical interpretations and media-exploiting ways to get public funds. The consequences for those who subscribe to his philosophy could be very bad, but of course, we won’t know that until it’s too late for these kids. That’s the crime.

  5. Alexander James

    One of the biggest disappointments in this article, of which there are many, is that it was authored by a person with financial and personal links with the people who are the topic of the article. Melissa Sweet has received funding from the Brain and Mind Research Institute (run by Hickie), and she reveals a personal discussion with Hickie’s mother. This is my first reading of Crikey, and really, i had expected a better quality of journalism than a defense of people who she obviously has personal and financial ties with. Hickie has been rightly criticised as he has succeeded in persuading a government that genuinely wants to help that the best way to go is simply to drug people. UK research has demonstrated that after the first 3 months of intervention, it is cheaper for a government to subsidise psychological help than psychiatric drugs. While cutting the publics access to psychologists from 18 to 10 sessions per year, the government now funds 50 visits per year to a psychiatrist- testimony to Hickie’s and McGorry’s persuasive powers. Most of what the majority of psychiatrists do is prescribe drugs- that is what they are equipped to do, whereas psychologists attempt to help people in problem solving and learning new life skills. The links between the pharmaceutical industry and psychiatry are complete- psychiatrists are merely the marketing outlets for drug companies. This is in the absence of any evidence to support the brain theories of mental illness, and even less evidence in support of their brain disabling interventions. McGorry, for his part (also the recipient of drug company funding) has proposed a model of early psychosis intervention which is more science fantasy than reality. International mental health authorities, people who stand to lose nothing financially by this fantasy, state that the false positives are around 7-8 out of 10. These young people will be drugged on the prospect that at some time in the future they may become psychotic, mostly because they have a psychotic parent- and 7-8/10 times they never were going to become psychotic anyway. Antipsychotic drugs cause Tardive Dyskenisia- permanent drug induced brain damage, resulting in Parkinson disease type symptoms. If McGorry gets his way, get used to seeing people in their mid 20’s shuffling and shaking like frail 80 year olds with Parkinsons disease. And this is why the Better Access program (which was clearly demonstrated by research to be a resounding success) has been slashed. More than 80,000 Australians are now going without the psychological services they need so that Hickie and McGorry are able to take us a huge step closer to their Brave New Psychiatric World of better living through drugs, where most of the population is being chemically altered by your friendly neighbourhood psychiatrist. Thanks Hickie and McGorry- the drug companies will be very pleased with your good work. Fortunately, unlike the American population, most Australians are too inherently skeptical to swallow this poison.

  6. ihaywood

    This article is very light on who the critics are and what they are actually saying, other than Jurendini. It’s odd that you largely quote third-parties speculating on the criticism and its motives: why not quote the critics directly?
    You also gloss over (or are underaware??) of the therapeutic differences: Hickie and McGorry largely espouse CBT and medication, the “ancien regime” more oriented to longer-term psychodynamic/attachment-based approaches.

  7. LJG..............

    As a consumer at times of anti-psychotics, the better access program, Lay Drug and Alcohol Programs like AA and NA , ECT and other psychiatric medication some of the things I am most tired and depressed by is:
    1. People who believe that every Mental Illness can be just treated by therapy without the use of medical intervention.
    2. Going to Funerals.

    From the little I know from an undergraduate psychology degree and what I’ve learnt over the years of my illness I realise how little we all know about Mental Illness . Yes treatments don’t always work and yes drugs have side effects and yes years of talking about a problem may not help and cost a lot of money. But we have to keep trying until we learn more.
    Debate is good but Hysteria and misinformation helps no-one.

    And I’m happy to answer any questions about my experiences of any of the above and I don’t have any Parkinson disease type symptoms I’m afraid.

    Regards, Lea.

  8. Thembi Soddell

    Although this article is fairly comprehensive I am just disappointed to not see any consumer opinions represented. I appreciate that this article reflects the sentiment that consumer needs should really be the top priority, but I don’t see how that is going to happen if consumers themselves are not included in the debate – and not just a token one or two, but a comprehensive range that reflect the extremely diverse needs of people living with mental illness and severe psychological distress. I feel like this is a gaping hole in the mental health reform debate and I’m hoping someone will fill it.

  9. Terry Taylor

    I’m a clinical psychologist in private practice in a rural area. The majority of the people I see are bulk-billed under Better Access. In a fact sheet sent to me recently by the Department of Health and Ageing, it was said “It is important that people get the right care for their needs. People who currently receive more than 10 allied mental health services under Better Access are likely to be patients (!) with more complex needs and would be better suited for referral to more appropriate mental health services. GPs can continue to refer those people with more severe ongoing mental disorders to Medicare subsidised consultant psychiatrist services or state/territory specialised mental health services.”

    The above demonstrates a lack of understanding of what the respective services deliver that literally takes my breath away. People who suffer depression, anxiety and all their permutations and combinations need long term treatment to change the habits, beliefs and attitudes of, often, most of their lives. This is, quite simply, what psychologists do. It is not what psychiatrists do, or are trained to do. Psychiatrists have a very necessary place. Yet when I try to refer a client to a psychiatrist for an assessment of their medication it is almost impossible to find someone they can see within any reasonable interval in my rural area.

    The changes to Better Access can only have a deleterious effect to clients with complex needs. It will prevent them from receiving the treatment they need. We have waited so long for an initiative that offers psychological care to those who cannot afford to fund it themselves, and now it is being snatched away.

  10. Chris Mackey

    I think this article misses the main point of concerns about Ian Hickie’s seemingly strongly bias against independent psychological services relative to psychiatry services. It is no secret that many psychiatrists were vehemently opposed to the Better Access scheme from its inception. Ian Hickie in particular has set out to attack the Better Access scheme from the outset. For example in numerous newspaper articles from a short time after the scheme was introduced he attacked the scheme for having no evidence for the effectiveness of services it supported. However, I do not believe that he ever challenged the Medicare-based funding for much more costly private psychiatry services despite these services attracting rebates for more than two decades with no independent evidence for their effectiveness. Such expensive and poorly validated private psychiatry services are still being subsidized for up to 50 sessions per year, seemingly with Ian Hickie’s blessing.

    In a single private practice in Geelong, Chris Mackey and Associates) we have now collected objective outcome data on over 800 adult clients seen through the Better Access scheme (see which we believes exceeds the cumulative total of direct objective evidence for the effectiveness of private psychiatry services by all private psychiatrists in Australia over a period of decades. The official Better Access report by Professor Jane Pirkis and colleagues released in March this year also provides much more evidence than currently exists for the effectiveness of private psychiatry services. So why have Ian Hickie (and Pat McGorry for that matter) not been prepared to challenge funding for private psychiatry services? This seems to represent a blatant form of bias. Our data on over 400 clients shows that the clients we have treated for depressive conditions have recovered just as well regardless of whether or not they were on prescribed medication. We have treated numerous clients effectively who had not responded well to years of prior private psychiatric treatment (especially those with trauma reactions). Cutting such private psychology services, as we have proved to be broadly effective, and seeking to redirect clients requiring more than ten sessions to more costly private psychiatry services, is likely to be a costly mistake. And yet this is what the government is now recommending through its fact sheets on the basis of advice from Ian Hickie, Pat McGorry and other advisors. It seems like blatant bias to me. It is the clients who will miss out. We have objectively demonstrated (see our website) that for those with severe depression, only those who receive more than ten sessions recover to near-normal levels. Many future such clients are likely to miss out following recommendations by Ian Hickie, Pat McGorry and others. I do not believe any current private psychiatry, or public mental health services for that matter, can match the results we have already demonstrated through the Better Access scheme. I have worked in public mental health for 15 years, and there is a marked lack of consistency in expertise. Cutting Better Access is not the answer.

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